Have you had a short sale, forclosure or not paid as agreed on your mortgage in the last 7 years?:

Yes &nbsp&nbsp
No

Do you have any credit problems or delinquent accounts?:

Yes &nbsp&nbsp
No

Comments:

Terms

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

Pelican Realty of Louisiana (the Company) may obtain information about you from a consumer reporting agency for tenant screening purposes.
Thus, you may be the subject of a consumer report and/or an investigative consumer report which may include information about your
character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources
such as your neighbors, friends, or associates. These reports may contain information regarding your criminal history, social security
trace, employment and education references, credit history, professional licenses and credentials. You have the right, upon written
request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative
consumer report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with
regard to applicants for residency is an investigation into your education and/or employment history conducted by CICTotal,
42913 Capital Dr, STE 101, Phone: 800.288.4757, Fax: 888.797.2254, or another outside organization. This Disclosure and Authorization
allows the Company to obtain from any outside organization all manner of consumer reports and investigative consumer reports now and,
if approved for residency, throughout the course of your tenancy to the extent permitted by law. As a result, you should carefully
consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report.

New York and Maine applicants or residents only: You have the right to inspect and receive a copy of any investigative consumer
report requested by Pelican Realty of Louisiana by contacting the consumer reporting agency identified above directly.

ACKNOWLEDGMENT AND AUTHORIZATION

I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT
REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of consumer
reports and/or investigative consumer reports at any time after receipt of this authorization and, if I am approved for residency,
throughout my tenancy. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or
federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to
furnish any and all background information requested by CICTotal, 42913 Capital Dr, STE 101, Phone:
800.288.4757, Fax: 888.797.2254, another outside organization acting on behalf of the Company,
and/or the Company itself. I agree that a facsimile (fax),
electronic or photographic copy of this Authorization shall be as valid as the original.

California applicants only: You have the right to inspect and receive a copy of any investigative consumer report request by
Pelican Realty of Louisiana by contacting the Company or the consumer reporting agency identified above directly. I understand that typing my
name and Social Security number below and clicking on the "Sign Application" button, constitutes my electronic signature, dated as of
when I click on the "Sign Application" button, and that by doing so:

I am authorizing CICTotal to conduct the background check(s) described above

I am consenting to use electronic means to sign this form and have read and understand the above disclosure

I acknowledge I may request a hard copy of this Disclosure and Authorization form after agreeing to the background check electronically by calling CICTotal at Phone: 800.288.4757, Fax: 888.797.2254.

Agree with the terms and conditions

$30 will be charged to your credit card upon submission. This amount includes; a Non Refundable Application fee of $30.00 and an Admin Fee of $0.00.

Once submitted, we will evaluate your application and respond to you within 24 hours.

Card Number

Expiration (MM/YY)

/

CVC

Postal Code

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Please enter a description for your Work Order.

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Please enter your Prospect First Name

Please enter your Prospect Last Name

Please enter your SSN

Please enter your DOB

Please enter your Drivers License

Please enter your Phone Number

Please enter your Email

Please enter your Current Address

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Please enter an amount greater than 0.

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By providing my credit ('Payment Method'), I AGREE that I have read and understand this Agreement. In addition I authorize 6904 Rosebank Drive to charge the full amount indicated above to the specified Payment Method; and I authorize the financial institution for the Payment Method specified above to charge my account and remit payment. This authority will remain in effect until I give notification, as required under this Agreement, to terminate this authorization; provided, however, that no termination of authorization will relieve me of any obligation to pay amounts due. I represent and warrant that I have full authority to enter into this Agreement and make the representations herein. I will cooperate to execute any documents that may be reasonably required to effectuate the foregoing authorization.

Your application has been submitted

We will evaluate your application and respond to you within 24 hours.

Payment!

Verifying your bank account!

Enter the two small deposits received in your account.

Please wait 2 business days after entering your bank account to receive the confirmation deposits.

There is a limit of 10 failed verification attempts. Once this limit has been crossed, the bank account will be unable to be verified.

Warning!

No Units available. Please contact the property manager

Renters Insurance Required!

6904 Rosebank Drive requires that all its tenants have renters insurance. Currently you do not appear to have renters insurance on file. You are welcome to purchase renters insurance from whatever provider you choose. We also provide a link to SURE which is a 3rd party, not affiliated with 6904 Rosebank Drive. Click here to get a quote from SURE.